Question:

Billing MRI and IAC together using Modifier 59

by Guest4937 | earlier

I need help to figure out what is the correct way to code and bill the MRI IAC , internal Auditory Canal, when I have both the MRI of brain and IAC requested by the referring physician .I have some documentation from AMA stating that if two separate and distinct MRI studies are performed, likebrain and IACs, it would be appropriate to code brain twice with a modifier 59 appended to the second study. My question is that is there anywhere a documentation regarding the billing of IAC that I can use when billing and coding?

Tags: 59, Billing, IAC, modifier, MRI, Using

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Harry

This is true for if the MRI of brain and IAC are done on same day using 59 on IAC. It would not be wrong to say that this method of billing is practiced by several medical service providers where they have billed two different treatments under the same CPT code. However, when it comes to the insurance companies making payments to the medical service providers, they always have an objection. Although there have been two different treatments but they are considered to be one. The insurance companies reason that a certain CPT code cannot be billed twice. They consider it as one treatment and make the payment accordingly. For those who provide the treatment, this often results in no gain if not a loss. The insurance companies have to be made this realized that the CPT codes for some treatments have not been derived so that is why they are billed with using modifier 59.

Report (0) (0) | 1 year ago
Guest10731614

The AMA says that you can report two brain MRIs (70551-70553) if you do scans of both the brain and the internal auditory canals (IACs). Snag: In order to code both studies, you need separate and distinct exams with separate and distinct indications. Just doing a few additional sequences of the IACs doesn't warrant coding an additional exam. And even if the exams meet the criteria for separate reporting, odds are the payer will deny the second service anyway.
Report (0) (0) | 2 years, 9 month(s) ago